The potential of radiologic procedures in the diagnosis of inflammatory bowel disease

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Abstract

At present, there is no "golden standard" of diagnosis of inflammatory bowel disease. Each and every individual case requires a thorough analysis of clinical symptoms in their association with endoscopic, histological, radiological and laboratory data. This review paper analyzes both conventional and novel methods of radiological investigations. Some of them have changed their significance from the "golden standard" to rare and limited application and from promising, then frequent and currently sporadic use of small bowel enema. Traditional ileocolonoscopy maintains its diagnostic potential, especially as a tool for follow up of patients with colonic and ileac disorders. The state-of-the-art non-invasive (ultrasound examination) and limitedly non-invasive (computerized tomography and magnetic resonance imaging) procedures are considered to be the most accurate methods for assessment of inflammatory bowel disorders in patient with already confirmed diagnosis and those with suspected cases of Crohn's disease and ulcerative colitis. The paper describes preparation of patient for each method, assessment technique, advantages and limitations for use, diagnostic criteria for intestinal wall thickness, accuracy of methods and discusses the perspectives of their use. The main sign of inflammatory bowel disease is thickening of intestinal wall. Usually its mean thickness in Crohn's disease (11 to 13 mm) is higher than that in ulcerative colitis (7 to 8 mm). This may provide a diagnostic key during differential diagnosis of an isolated colon disease. The amount of the contrast cumulated by the intestinal wall directly correlates with inflammation activity. Intensive contract cumulation in the intestinal wall after intravenous contrast enhancement is a symptom of active inflammatory process. However, despite progression in the technologies, initial signs of inflammatory bowel diseases are quite superficial and remain hardly visible, being below the resolution ability of any diagnostic investigation.

About the authors

S. E. Dubrova

Moscow Regional Research and Clinical Institute, Moscow

Author for correspondence.
Email: dubrovamoniki@rambler.ru

Dubrova Sofiya E. – MD, PhD, Physician, Department of Roentgenology; Assistant, Chair of Radiology, Postgraduate Training Faculty.

61/2-1 Shchepkina ul., Moscow, 129110, Russian Federation. Tel.: +7 (495) 681 66 42. E-mail: dubrovamoniki@rambler.ru Россия

G. A. Stashuk

Moscow Regional Research and Clinical Institute, Moscow

Email: fake@neicon.ru
Stashuk Galina A. – MD, PhD, Professor, Chief Research Fellow, Department of Roentgenology; Chair of Radiology, Postgraduate Training Faculty Россия

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